Hip Arthroscopy: Peripheral Compartment Access
Femoroacetabular impingement (FAI) has recently been recognized as a source of hip pain and motion restriction. Femoral morphology contributes to both cam and pincer FAI and is surgically addressed by accessing the peripheral compartment to restore normal femoral offset and sphericity. One of the more difficult aspects of hip arthroscopy is visualization and treatment of cam-type morphology in the peripheral compartment. The extracapsular technique for arthroscopic access explained in this chapter uses the anterior portal, anterolateral portal (ALP), and distal anterolateral access (DALA) portal. These portals allow access to the zona orbicularis and anterolateral aspect of the labrum and femoral neck while giving ergonomic access for femoral osteochondroplasty.Moreover, the DALA portal offers an ideal trajectory for positioning suture anchors while allowing for an easy additional lengthwise incision of the joint capsule. While several extracapsular access and exposure techniques are utilized, this chapter details our technique for exposure and 180-degree visualization of the femoral neck in the peripheral compartment using a T-capsulotomy.
